Correct!
1. Comparison to prior chest radiography
Whenever a lesion is discovered at chest imaging, comparison to older chest imaging studies is of paramount importance. If a chest lesion can be shown to be stable for a significant length of time, the evaluation of a chest lesion may be tempered, saving expense, potential radiation exposure, patient anxiety, and possibly even complications. Further evaluation with cross sectional imaging or 18FDGPET may occasionally be averted with this approach, the latter typically employed after a nodule at chest radiography has been evaluated with chest CT and found to be indeterminate. Lateral decubitus chest radiography is usually reserved for assessment of layering pleural effusion [with the affected side dependent] or pneumothorax [with the affected side non-dependent].).
A chest radiograph performed one year earlier, prior to the patient’s cardiac transplantation, was located for comparison (Figure 2).
Figure 2: The current frontal and lateral chest radiograph (A and B) is compared with a prior frontal and lateral chest radiograph just 12 months earlier (C and D), and shows that the left upper lobe nodule (arrow) is new. The patient’s heart transplant had been performed in the interval between the two examinations- note the abandoned defibrillator lead remaining in the native superior vena cava.
Given this comparison, which of the following represents an appropriate differential diagnostic consideration for the patient’s presentation chest radiographic findings? (Click on the correct answer to be directed to the fourth of nine pages).